Provider Demographics
NPI:1487655486
Name:VEGA BAJA MEDICAL SERVICES INC.
Entity Type:Organization
Organization Name:VEGA BAJA MEDICAL SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:D
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN
Authorized Official - Phone:787-855-7202
Mailing Address - Street 1:PO BOX 1327
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00694-1327
Mailing Address - Country:US
Mailing Address - Phone:787-855-7202
Mailing Address - Fax:787-807-6721
Practice Address - Street 1:URB. BRASILIA MARGINAL #2
Practice Address - Street 2:ESQ. CALLE 2 D-10 SUITE #3
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693
Practice Address - Country:US
Practice Address - Phone:787-855-7202
Practice Address - Fax:787-807-6721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR05-P-1381332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0815440001Medicare NSC